During a consultation with a cardiologist or surgeon, the patient may be diagnosed with dilatation jugular vein on the neck, the reasons for this phenomenon are different. Depending on the predisposing factors, a treatment regimen is prescribed.
The function of the jugular veins is to be responsible for the process of blood flow from the brain to the neck. Thanks to these blood veins, unpurified blood flows to the heart muscle so that the filtration process can take place.
Jugular veins are divided into several types:
Phlebectasia disrupts the functioning of valves and blood vessels. Flow regulation is suspended venous blood. Clots appear. At large quantities Such formations develop dysfunction of the entire venous network.
If the jugular vein is dilated even slightly, it is manifested by the following symptoms:
Signs of pathology depend on the stage:
When the left or right internal jugular vein expands, disturbances in the activity of the circulatory system occur.
Phlebectasia can occur at any age. Probable reasons:
The disease takes time to develop. Even if a person has predisposing factors, this does not mean that he is already sick. It is necessary to monitor your health more carefully.
Predisposing factors include:
Hormonal causes of pathology are more common in women. During puberty and pregnancy, there is a risk that the veins will swell.
Among other factors - depressive states, stress. The jugular veins have nerve endings. If all is well, these endings form venous vessels high elasticity. But when a person is stressed, intravenous pressure increases, which impairs the elasticity of the veins.
Other unfavorable factors include:
If an increase is noticed on the right or on the other side, there is a possibility that this is only the first stage. But you should not self-medicate. With such a sign, you need to consult a doctor, who will make a diagnosis based on a visual examination.
To identify pathology that has reached the second or third stage, research is carried out. If a patient comes to an appointment complaining of pain, there is a possibility that blood flow is disrupted. The doctor prescribes laboratory tests- UAC - and instrumental methods research:
Sometimes a joint consultation with a vascular surgeon, therapist, neurologist, cardiologist, endocrinologist and a doctor specializing in oncological pathologies is necessary.
When prescribing treatment, take into account:
For example, the presence of venous cervical seals on the right does not pose a significant threat. But the disease on the left side is more dangerous: there is a risk of lymphatic system disorders if a thorough diagnosis is carried out.
The patient may be prescribed a course of medication. Prescribed drugs that can remove inflammatory processes, eliminate swelling, strengthen vascular walls.
If the patient is diagnosed with the third stage, it is indicated surgical treatment. Operations are performed to remove the affected areas of the veins. The healthy parts of the veins are connected to form a new vessel.
The same methods are used to treat children. During therapy in early age surgical intervention is often required.
What to do to prevent the onset of the disease - take preventive measures. Among them:
It is important to prevent complications, for which lifestyle should be adjusted, especially if there were people in the family with phlebectasis.
It is especially dangerous if the pathology occurs in a child. The disease is diagnosed immediately after birth, sometimes at 3-5 years. This is indicated by tumor-like neoplasms and elevated temperature.
Thrombosis becomes a complication. A clot forms inside the vessel. This indicates the presence of chronic diseases in the body. The danger of a blood clot is that it can break off and block the functioning of vital veins.
For those who experience thrombosis, the doctor recommends anticoagulants. Antispasmodics, venotonics, nicotinic acid used to relieve inflammation, relax muscles, and make blood more fluid. The drugs also help in resolving the blood clot. If the therapeutic regimen is successful, there is no need to perform surgery.
To avoid complications, when signs appear, you need to come for a diagnosis and take therapeutic measures. If you don't control the flow pathological process, consequences arise. For example, the affected area may rupture, causing hemorrhage. Most unfavorable outcome- death of the patient.
Subcutaneous fat
When examining subcutaneous fat tissue, attention is paid to the degree of development, places of greatest fat deposition and the presence of edema.
Obesity — overdevelopment subcutaneous fat, which leads to weight gain. The degree of development of subcutaneous fat is currently assessed by calculating the so-called body mass index (BMI), which is defined as the quotient of body weight (in kilograms) divided by body surface area (in m2), which is determined using special formulas or nomograms. In table 1 presents the classification of overweight and obesity depending on the BMI value.
Table 1. Classification of overweight and obesity depending on BMI (WHO, 1998)
As BMI increases, the risk of developing serious illnesses cardiovascular system, complications and fatal outcome. Most high risk observed in the abdominal type of obesity, to identify which the ratio of the waist circumference to the circumference of both hips is read. Normally, this ratio is 1.0 for men and 0.85 for women.
Edema may occur when various diseases internal organs. The severity of edema syndrome can vary: from slight pastiness of the subcutaneous tissue to anasarca with severe edema and accumulation of fluid in the serous cavities (ascites, hydrothorax, etc.). It should be remembered that the body of an adult can retain up to 3-5 liters of fluid without the appearance of swelling visible to the eye and palpable ("hidden edema").
Ways to detect edema:
Palpation method - pressing the thumb on the skin and subcutaneous tissue in the area of the ankles, legs, sacrum, sternum, where dimples remain in the presence of edema;
Monitoring the dynamics of body weight;
Measuring the amount of fluid you drink and urine output (diuresis).
The last two methods are most suitable for identifying hidden edema.
Swelling of the neck veins
This important sign stagnation of blood in the venous bed of the systemic circulation and increased central venous pressure (CVP). An approximate idea of its size can be obtained by examining the veins of the neck. In healthy individuals, in a supine position with the head of the bed slightly elevated (approximately 45°) superficial veins the necks are not visible or are filled only within the lower third of the cervical section of the vein approximately to the level of a horizontal line drawn through the manubrium of the sternum at the height of the angle of Louis (II rib). When the head and shoulders are raised, the filling of the veins decreases and disappears in vertical position. When venous blood stagnates in big circle blood circulation filling the veins is significantly higher than the level of the angle of Louis, remaining when raising the head and shoulders and even in a vertical position.
A positive venous pulse is most often detected with tricuspid valve insufficiency, when during systole some of the blood from the right ventricle (RV) is thrown into the right atrium(PP), and from there - to large veins, including the veins of the neck. With a positive venous pulse, the pulsation of the neck veins coincides with ventricular systole and the carotid pulse.
Abdominal-jugular (or hepato-jugular) reflux
Its presence indicates increased central venous pressure. An abdominal-jugular test is carried out during quiet breathing by briefly (for 10 s) pressing the palm of the hand on the anterior abdominal wall in the peri-umbilical region. Pressure on the anterior abdominal wall and an increase in venous blood flow to the heart are normal with sufficient contractility The pancreas is not accompanied by swelling of the jugular veins and an increase in central venous pressure. Only a small (no more than 3-4 cm H2O) and short-term (the first 5 s of pressure) increase in venous pressure is possible. In patients with biventricular (or right ventricular) CHF, decreased pumping function RV and stagnation in the veins of the systemic circulation when performing the test, there is an increase in swelling of the veins of the neck and an increase in central venous pressure by at least 4 cm water column. Positive results samples indicate the presence of stagnation in the veins of the systemic circulation caused by right ventricular failure. A negative test result excludes heart failure as a cause of edema.
Thus, appearance patients with biventricular (left and right ventricular) CHF is very typical. They usually assume an orthopneic position with their legs down. They are characterized by severe swelling lower limbs, acrocyanosis, swelling of the neck veins, a noticeable increase in abdominal volume due to ascites, sometimes swelling of the scrotum and penis in men. The face of patients with right ventricular and total heart failure is puffy, the skin is yellowish-pale with pronounced cyanosis of the sub, tip of the nose, ears, the mouth is half open, the eyes are dull (Corvisar's face).
A.V. Strutynsky
Complaints, anamnesis, physical examination
Sharply protruding and crimped temporal arteries observed in patients with hypertension and atherosclerosis.
When examining the neck of a patient with aortic valve insufficiency, pulsation can be seen carotid arteries(“carotid dance”) In this case, a peculiar phenomenon may be observed, expressed in head shaking (Musset's symptom). It occurs due to a sharp pulsation of the carotid arteries with differences in maximum and minimum pressure. The symptom of “carotid dancing” is sometimes combined with pulsation of the subclavian, brachial, radial and other arteries and even arterioles (“pulsating man”). In this case, it is possible to define the so-called precapillary pulse(Quincke pulse) - rhythmic redness in the systole phase and blanching in the diastole phase of the nail bed with light pressure on its end (Fig. 36, a). The precapillary pulse can also be seen on the mucous membrane of the lips when pressing on them with glass (Fig. 36, b) or when rubbing the skin of the forehead, as a result of which the color of the pulsating spot changes from hyperemia to pallor and vice versa.
Rice. 36. Determination of capillary pulse in the area of the nail bed (a) and on lower lip(b).
In an upright position of the patient, pulsation and swelling of the jugular veins are sometimes detected on the neck, which occurs due to difficulty in the outflow of venous blood into the right atrium. When outflow through the superior vena cava is difficult, the veins of the head, neck, upper limbs, the front surface of the body and the blood is directed from top to bottom, into the inferior vena cava system. When outflow through the inferior vena cava is difficult, the veins of the lower extremities, as well as the lateral surfaces of the abdominal wall, dilate and the blood is directed from bottom to top, into the system of the superior vena cava. If there is difficulty in outflow through portal vein A network of collaterals develops around the navel and blood is directed through the dilated superficial veins to the system of the superior and inferior vena cava.
On the neck you can notice pulsation and jugular veins ( venous pulse). Their alternating swelling and contraction reflect fluctuations in pressure in the right atrium depending on the activity of the heart. Slowing the outflow of blood from the veins to the right atrium with increasing pressure in it during atrial systole leads to swelling of the veins. The accelerated outflow of blood from the veins into the right atrium when the pressure in it decreases during ventricular systole causes collapse of the veins. Therefore, during systolic dilatation of the arteries, the veins collapse - negative venous pulse.
U healthy person the swelling of the veins is clearly visible if it is in supine position. When the position changes to vertical, the swelling of the veins disappears. However, in cases of insufficiency tricuspid valve, exudative and adhesive pericarditis, pulmonary emphysema, pneumothorax, the swelling of the veins is clearly visible in the vertical position of the patient. It is caused by stagnation of blood in them. For example, with tricuspid valve insufficiency, the right ventricle with each contraction throws part of the blood back into the right atrium, which causes an increase in pressure in it, a slowdown in the flow of blood into it from the veins, and severe swelling of the jugular veins. In such cases, the pulsation of the latter coincides in time with the systole of the ventricles and the pulsation of the carotid arteries. This is the so-called positive venous pulse. To identify it, it is necessary to push out the blood from the upper part of the jugular vein with a finger movement and press the vein. If the vein quickly fills with blood, this indicates its retrograde flow during systole from the right ventricle into the right atrium.
Rice. 37. Stokes collar (according to A.L. Myasnikov, 1956).
A sharp expansion of the veins of the neck with simultaneous sharp swelling (Stokes collar; Fig. 37) is caused by compression of the superior vena cava.
Dilatation of the cutaneous veins in the area of the manubrium of the sternum and the anterior wall chest observed with mediastinal tumors compressing the deep veins.
Pronounced pulsation in the epigastric region can occur due to contraction of the dilated and hypertrophied right ventricle (heartbeat) or pulsation abdominal aorta. In this case, the pulsation caused by the right ventricle is better visible under the very xiphoid process, especially with a deep breath, in a standing position. The pulsation of the abdominal aorta is more clearly visible slightly lower than the previous one when the patient is lying down, especially on exhalation.
Liver pulsation can be transmitted or true. The first is due to the transmission of heart contractions to the liver. In this case, the entire mass of the liver moves in one direction. True pulsation is expressed in alternating increases (swelling) and decreases in liver volume. It is observed, for example, with aortic valve insufficiency, and the swelling of the liver coincides in time with the apical impulse. In this case, the liver pulsation is arterial. With tricuspid valve insufficiency, true venous pulsation of the liver is observed, occurring as a result of regurgitation (reverse flow) of blood through an open opening from the right ventricle into the right atrium, and from there into the inferior vena cava and hepatic veins. The latter causes swelling of the liver.
1. How to palpate to distinguish the pulsation of the internal jugular vein from the pulse in the carotid artery?
Normally, the jugular venous pulse is not palpable.
If the venous pressure is extremely high, then in some cases you can feel gentle wave-like vibrations with your fingers.
Note:
A. Pressure on the supraclavicular region stops the jugular pulsation, but never eliminates the pulsation of the carotid artery.
However, there is one subtlety here that should be remembered. Very high and strong pulsation of the jugular vein does not disappear when pressing on the lower region of the supraclavicular space. In order to stop the high-amplitude pulsation of the jugular vein with high venous pressure, it is necessary to press at least on the middle of the neck (Fig.
Rice. 8. Very intense jugular pulsation does not disappear with pressure directly above the clavicle, possibly because the sternocleidomastoid tendon prevents adequate compression of the jugular vein
b. Sudden and sharp pressure on the abdomen instantly makes the jugular pulsation more noticeable, but has no effect on the pulsation of the carotid artery.
How can you distinguish jugular pulsation from carotid pulsation based on the pulse wave contour?
If the most pronounced rapid impulse is directed inward (i.e., it represents a collapse), then the source of pulsation is the jugular veins. The most extensive and rapid pulse movements in the carotid artery are directed outward.
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Pulsation (lat. pulsatio, from pulsus - push) is jerky vibrations of the walls of blood vessels, the heart and adjacent tissues. There are physiological and pathological pulsations.
Pathological pulsation of the heart and blood vessels in the chest area, epigastric and hepatic pulsation are of diagnostic importance.
Pronounced pulsation of the aorta can be detected in the 1st or 2nd intercostal space to the right of the sternum with cicatricial wrinkling right lung or due to a sharp expansion of the ascending aorta (see Aortic aneurysm). Aortic pulsation can also be detected in the jugular fossa with sclerotic elongation of the aorta and with expansion or aneurysm of its arch.
With an aneurysm of the innominate artery, a “pulsating tumor” is noted in the area of the sternoclavicular joint. Ripple pulmonary artery determined in the second intercostal space on the left in case of shrinkage of the left lung or dilatation of the pulmonary artery (hypertension in the pulmonary circulation).
Tumors in contact with the heart or large vessels can cause abnormal pulsation in the chest area.
A sharp displacement of the heart in diseases of the respiratory system and a change in the location of the diaphragm leads, in connection with the displacement of the cardiac and apical impulse, to the appearance of an unusual pulsation in the chest area: in the III, IV intercostal spaces on the left with significant wrinkling of the left lung and high standing of the diaphragm, in the III-V intercostal spaces behind the left midclavicular line with accumulation of fluid or gas in the right pleural cavity, on the right in the IV-V intercostal spaces along the edge of the sternum with wrinkling of the right lung, with left-sided pneumo- or hydrothorax or dextrocardia.
Drooping of the diaphragm with emphysema can lead to a displacement of the apex impulse down and to the right.
In the neck, arterial and venous pulsations are distinguished. Increased pulsation of the carotid arteries is observed with insufficiency aortic valves, aortic aneurysm, diffuse thyrotoxic goiter, arterial hypertension.
Single-wave pulsation of the jugular veins in pathological conditions can be either presystolic or systolic (positive venous pulse). Accurate character pathological pulsation of the veins is determined on a venogram (see). Upon examination, you can usually see pronounced pulsation in the form of one wave, less often two, after contraction of the atria (presystolic) or synchronously with ventricular systole (systolic).
The most typical systolic pulsation of the jugular veins with simultaneous systolic pulsation of the enlarged liver with tricuspid valve insufficiency. Presystolic pulsation occurs with complete heart block, stenosis of the right venous opening, sometimes with atrioventricular rhythm and paroxysmal tachycardia.
Epigastric pulsation can be caused by contractions of the heart, abdominal aorta, and liver.
Heart pulsation in this area is visible when the diaphragm is low and the right side of the heart is significantly enlarged. Pulsation of the abdominal aorta can be seen in healthy, thin people with flaccid abdominal wall; more often, however, it occurs in the presence of tumors abdominal cavity in contact with the abdominal aorta, and sclerosis or aneurysm of the abdominal aorta. Hepatic pulsation is better determined by palpation of the right lobe of the liver. True pulsation of the liver is extensive in nature and is manifested by a rhythmic increase and decrease in the volume of the liver due to the changing filling of its vessels with blood (see.
Heart defects). Liver pulsation visible to the eye is determined by hemangioma.
Pathological pulsation of the arteries is observed when the walls of blood vessels harden and cardiac activity increases during various pathological conditions body.
Graphic recording of pulsation using multichannel instruments allows you to more accurately determine its nature.
Swelling of the veins, accompanied by a visible pulsation, suddenly appearing in the submandibular area is a symptom that requires close attention, and sometimes the help of a qualified doctor.
Read on to learn what to do if a vein in your neck is pulsating and what it may signal.
In an absolutely healthy person who has no serious problems with health, pulsation can occur after undergoing high-intensity physical activity.
In some patients this is how nervousness manifests itself, while in others the vein begins to pulsate as a reaction to severe stress.
The symptoms are not associated with diseases of the veins, heart, blood vessels or other internal organs; as a rule, they do not pose any danger if they occur once. If you notice a connection between stress and pulsating veins, you may want to consult a neurologist.
The main cause of pulsation of the veins in the neck: heart failure in the right ventricle, accompanied by stagnation of venous blood in the systemic circulation.
At the same time, the vein does not just pulsate, it swells and expands.
When does it occur pulse wave on the neck, it can not only be easily felt, it can be seen from the side.
Pulsation of the neck veins may occur if you have the following health problems:
If you notice that the pulsation of a vein in your neck has begun to occur with regular frequency, this is an alarming signal.
Consultation with a doctor is required.
The following are responsible for diagnosing and treating these symptoms: a therapist and a cardiologist. They can refer you to more specialized specialists, which include a rheumatologist, endocrinologist, oncologist, cardiac surgeon, and pulmonologist.
The primary study when a patient complains that a vein in the neck is pulsating is a palpation examination.
The doctor evaluates:
Note that pulsation can be caused by disturbances in the outflow of blood in the veins (venous) or in the arteries (arterial).
The doctor determines this during the initial examination.
To establish more accurate diagnosis One or more of the following tests may be needed:
It is important to know: the problem often affects people with overweight, so the doctor pays attention to the patient’s build.
How is the presence of fat related to the pulsation of veins?
Fatty fiber directly affects cardiovascular system: on the one hand, fat is deposited around the heart, making it difficult to work; on the other hand, the heart has to work much harder, because the tissues in the body full man much more and more blood also needs to be transferred.
The pulsation of the veins in the neck is only a symptom, and not an independent disease, therefore, when identifying the final cause of the symptoms and making a diagnosis, the doctor treats the underlying disease.
When tumors are detected, therapy is aimed at their removal.
Heart failure and arrhythmia are treated with lifelong treatment medications. In case of aneurysm, atherosclerosis and some other problems, the doctor may decide to perform an operation, but this practice is used if the vessels are severely compressed or blocked, which interferes with normal blood circulation.
If you notice a throbbing area on your neck once or twice, this does not mean there is a serious danger to your health.
But regularly occurring pulsation is a symptom that you should definitely tell your doctor about, even if nothing else bothers you.
By the level and nature of pulsation of the veins of the neck, one can judge the state of the right parts of the heart. The pulsation of the internal jugular vein on the right most accurately reflects the state of hemodynamics. The external jugular veins may be dilated or collapsed due to extracardiac influences - compression, venoconstriction. Although the right internal jugular vein is not visible, its pulsation is judged by the oscillation of the skin over the right clavicle - from the supraclavicular fossa to the earlobe, outward from the carotid artery.
Observation is carried out with the patient lying down with the torso elevated - 30-45°, the neck muscles should be relaxed (Fig. 6).
Rice. 6. Visual definition Central venous pressure (in a patient, central venous pressure = 5 cm + 5 cm = 10 cm water column)
Normally, pulsation is noticeable only in the area of the right supraclavicular fossa.
For each pulsation of the carotid artery, a double oscillation of the venous pulse is noted. Unlike the pulsation of the carotid arteries, the pulsation of the vein is smoother, is not felt during palpation and disappears if the skin above the collarbone is pressed.
In healthy people, in a sitting or standing position, pulsation of the veins of the neck is not visible. By the upper level of pulsation of the right internal jugular vein, you can approximately determine the value of the central venous pressure: the angle of the sternum is located at a distance of about 5 cm from the center of the right atrium, therefore, if the upper level of pulsation is not higher than the angle of the sternum (only in the supraclavicular fossa), the central venous pressure is equal to 5 cm of water column, if the pulsation is not visible - the central venous pressure is below 5 cm of water.
Art. (in these cases, pulsation is noticeable only in a horizontal position of the body), if the level of pulsation is higher than the angle of the sternum, to determine the central venous pressure, add 5 cm to the value of this excess, for example, if the upper level of pulsation exceeds the level of the sternum angle by 5 cm, the central venous pressure is 10 cm ( 5 cm + 5 cm) water.
Art. Normally, the central venous pressure does not exceed 10 cm of water. Art. If the pulsation of the neck veins is noticeable in a sitting position, the central venous pressure is significantly increased, at least 15-20 cm of water.
Art.
The venous pulse normally consists of two rises (positive waves “a” and “V”) and two
When observing the pulsation of the neck veins, it is easiest to identify:
1. Increased central venous pressure - clearly visible pulsation of the veins of the neck in a sitting position, usually swelling of the external veins of the neck.
2. A sharp decrease in central venous pressure (hypovolemia) in patients with clinical picture collapse or shock - absence of pulsation of the veins of the neck and collapse of the saphenous veins even in a horizontal position.
3.
Atrial fibrillation - absence of the “a” wave of the venous pulse.
4.
Atrioventricular dissociation - irregular “giant” waves of venous pulse.
When pressing with the palm of your hand on the abdomen in the area of the right hypochondrium, the so-called hepatojugular reflux is noted - an increase in the level of pulsation of the veins of the neck. Normally, this increase is short-term, but in patients with congestive heart failure it persists throughout the entire time of pressure on the liver area.
Determination of hepatojugular reflux is carried out in patients with normal central venous pressure, for example, after taking diuretics.
Swelling of the veins, accompanied by a visible pulsation, suddenly appearing in the submandibular area is a symptom that requires close attention, and sometimes the help of a qualified doctor. Read on to learn what to do if a vein in your neck is pulsating and what it may signal.
In an absolutely healthy person who does not have serious health problems, pulsation may occur after undergoing high-intensity physical activity. In some patients this is how nervousness manifests itself, while in others the vein begins to pulsate as a reaction to severe stress. The symptoms are not associated with diseases of the veins, heart, blood vessels or other internal organs; as a rule, they do not pose any danger if they occur once. If you notice a connection between stress and pulsating veins, you may want to consult a neurologist.
The main cause of pulsation of the veins in the neck: heart failure in the right ventricle, accompanied by stagnation of venous blood in the systemic circulation.
At the same time, the vein does not just pulsate, it swells and expands.
When a pulse wave occurs in the neck, it is not only easily palpable, but can be seen from the side.
Pulsation of the neck veins may occur if you have the following health problems:
If you notice that the pulsation of a vein in your neck has begun to occur with regular frequency, this is an alarming signal.
Consultation with a doctor is required. The following are responsible for diagnosing and treating these symptoms: a therapist and a cardiologist. They can refer you to more specialized specialists, which include a rheumatologist, endocrinologist, oncologist, cardiac surgeon, and pulmonologist.
The primary study when a patient complains that a vein in the neck is pulsating is a palpation examination.
The doctor evaluates:
Note that pulsation can be caused by disturbances in the outflow of blood in the veins (venous) or in the arteries (arterial). The doctor determines this during the initial examination.
To establish a more accurate diagnosis, one or more of the following tests may be needed:
It is important to know: the problem often affects overweight people, so the doctor also pays attention to the patient’s build. How is the presence of fat related to the pulsation of veins?
Fat fiber directly affects the cardiovascular system: on the one hand, fat is deposited around the heart, making it difficult to function; on the other hand, the heart has to work much harder, because there are much more tissues in the body of a full person and more blood also needs to be transferred.
The pulsation of the veins in the neck is only a symptom, and not an independent disease, therefore, when identifying the final cause of the symptoms and making a diagnosis, the doctor treats the underlying disease.
When tumors are detected, therapy is aimed at their removal. Heart failure and arrhythmia are treated with lifelong medication. In case of aneurysm, atherosclerosis and some other problems, the doctor may decide to perform an operation, but this practice is used if the vessels are severely compressed or blocked, which interferes with normal blood circulation.
If you notice a throbbing area on your neck once or twice, this does not mean there is a serious danger to your health. But regularly occurring pulsation is a symptom that you should definitely tell your doctor about, even if nothing else bothers you.
Swelling of veins in the neck is a direct symptom of increased venous blood pressure. In a healthy person, it can be observed in a lying position with the head elevated at 45 degrees. The pulsation and swelling of the veins disappears when the person takes a horizontal position. Swelling of the veins in the neck is also observed in patients with a number of serious diseases.
